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1986, 07-23 Permit App: 00012251 Water SoftenerPLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF,THE FORM YOU UNDERSTAND IProtect k 2 25/ Owner's Name Last First MI REES RANDY Project Address (Street Name & Number) City State Subd on/Plat Name 'Oft©/ -(c912 QST Assessors Parcel if� ��/ G r /�� Lot � Block � Plat # Applicant Same Address S. 3508 Sundown CityState Spokane I WA Zip 99206 Phone 927-0706 Business Phone Contractor Soft Water Service Co. Address E. 25 Third CityState Spokane I WA Zip 99202 Phone 455-8050 Contact License # Business Phone Describe Work . Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): Doh Wahr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s): Urinal(s): Wtr Closet (s): Lav(s): Shower(s): Tub(s): Bidet(s): a)Other: w cc Type; Water Softener m XWaste/Grease Interceptor(s): II LL O 2 Sewer Y N Septic/Health No.: Ill CO 2 Electric Water Heater(s): Drains -Root: n Z REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment: Y N Lawn Sprinkler System(s), including backflow device on any one meter: Vacuum breakers or backflow devices in excess of line 16: 1-5: (Or) 5+: I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state of local laws regulating construction or the performance of construction. SIGNATURE OF APPLICATION OWNER OR AGENT Soft Water Service Co. DATE